Essential Balance Training for Cancer Patients: Reducing Fall Risk During and After Treatment

Balance training for cancer patients is one of the most effective ways to reduce the risk of falls during and after treatment. A deterioration in balance is extremely common among people undergoing cancer treatment, often as a direct side effect of chemotherapy or other therapies. Poor balance increases the risk of falls and fractures, injuries that can seriously disrupt recovery and quality of life. The good news is that balance can be significantly improved with the right, targeted exercise program.

Why Cancer Treatment Affects Balance

Muscle loss from chemotherapy Chemotherapy commonly causes a decline in muscle mass throughout the body, including the legs. Without adequate leg strength, it becomes much harder to catch yourself or correct your footing the moment you start to trip. Over time, this loss of strength can quietly erode the everyday stability most of us take for granted, making falls far more likely, even during simple tasks like walking around the house or standing up from a chair. This is precisely why balance training for cancer patients should focus on rebuilding leg strength as a first priority.

Peripheral neuropathy Chemotherapy can also cause peripheral neuropathy (CIPN) – a loss of sensation, numbness, or tingling in the fingers and feet. Because your feet play such a critical role in sensing the ground beneath you and helping your brain make constant micro-adjustments to stay upright, reduced sensation here has an outsized impact on stability. Peripheral neuropathy can persist for weeks, months, or even years after treatment has finished, and research shows it can significantly increase a person’s risk of falls.

A growing body of research points specifically to sensorimotor training – exercise that challenges balance, coordination and proprioception through methods like unstable surfaces, controlled perturbations and precision stepping drills – as a particularly effective approach for CIPN-related balance deficits, generally outperforming standard strength training alone for this specific problem. There is also early but promising evidence that starting sensorimotor and resistance training during neurotoxic chemotherapy may help reduce the severity of CIPN symptoms as they develop, rather than only managing them after the fact. This research is still evolving, but it strengthens the case for beginning balance training for cancer patients as early as possible, ideally alongside chemotherapy, rather than waiting until neuropathy has already taken hold.

What Are Sensorimotor Exercises?

Sensorimotor exercises are a distinct category of balance training for cancer patients, separate from simple functional exercises like sit-to-stands or mini squats. Where functional exercises mainly build the strength needed to hold a position or push up from a chair, sensorimotor exercises specifically retrain the communication between your feet, joints, muscles and brain, the system most disrupted by CIPN. This makes them particularly relevant if you’re experiencing numbness or tingling in your feet, rather than a general strength or fitness exercise.

Examples used in clinical settings and research include:

• Foam pad standing. Standing on a soft, unstable foam surface forces your body to make constant small corrections, helping retrain balance control even when sensation in the feet is reduced.
• Perturbation training. Controlled, unexpected nudges or surface movements (often guided by a physiotherapist) train your body to react and recover quickly, replicating the split-second corrections needed to prevent a real fall.
• Progressive surface challenges. Gradually moving from a stable floor to less predictable surfaces, such as a folded towel, wobble cushion, or wobble board, builds tolerance to the kind of uneven ground you’ll encounter in everyday life.
• Eyes-closed balance tasks. Removing visual input during simple standing or weight-shifting exercises forces the body to rely more heavily on feedback from the feet and joints, directly targeting the sensory deficits caused by CIPN.

These exercises should be introduced gradually and, particularly in the early stages, with support from a chair, table, or physiotherapist nearby, since they’re intentionally designed to challenge your balance under safe, controlled conditions.

Tips to Reduce Your Risk of Falls During Exercise

Effective balance training for cancer patients doesn’t need to be complicated. Small, consistent changes to how you exercise can make a big difference to your stability and confidence.

• Prioritise multimodal programs. Research comparing exercise approaches for CIPN-related balance problems consistently finds that programs combining aerobic, resistance, balance and sensorimotor training are more effective than isolated strength training on its own. A well-rounded program beats leg exercises in isolation.
• Include sensorimotor exercises. As outlined above, these are considered one of the more targeted ways to address CIPN-related balance deficits specifically, and are best introduced under guidance from your physiotherapist.
• Build leg strength. Stronger legs improve standing balance and help you recover quickly if you start to lose your footing. Simple exercises like sit-to-stands and mini squats are a great place to start.
• Use treadmill handles. Always hold the handles for support when walking on a treadmill, even if your balance feels fine on a given day.
• Try a recumbent bike. It offers both cardiovascular and strength benefits while significantly lowering fall risk compared with upright equipment.
• Ask your physiotherapist about standing exercises. These are more functional for everyday life, since they mimic the balance challenges you face at home. Always use a chair or table for support while performing them, particularly in the early stages.
• Wear supportive, well-fitted footwear. Good shoes with proper grip make a real difference to stability, especially if you’re experiencing any numbness or tingling in your feet.
• Time your exercise around your energy levels. Fatigue affects concentration and reaction time, both of which are important for balance. If fatigue is an issue, choose the time of day when you typically feel strongest.

When Should You Start Exercising?

The sooner, the better – for your quality of life at every stage of your cancer journey. Starting balance training for cancer patients early can make the transition through each phase of treatment noticeably smoother.

Exercise is beneficial throughout treatment, not just afterwards:

• Before treatment or surgery. Current evidence increasingly supports formalised prehabilitation programs as significantly improving outcomes. There’s also early evidence that starting sensorimotor and resistance training before or during neurotoxic chemotherapy may help reduce the risk of developing CIPN in the first place, rather than only addressing it once symptoms appear.
• During treatment. Some evidence suggests exercise may help the body respond better to treatment, reduce the amount of muscle mass lost, and help manage fatigue.
• After treatment. Exercise is invaluable for rebuilding strength back to your baseline, directly addressing issues such as decreased balance that may have developed along the way, and improving your overall well-being.

As always, make sure you get medical clearance from your treatment team before commencing any exercise program.

Get Support From a Cancer Rehabilitation Specialist

Physiotherapist Luci Minogue runs Inner Strength Bayside’s Cancer Rehabilitation program, offering tailored balance training for cancer patients at every stage of treatment and recovery. Call us today on 8555 4099 or book online to begin your cancer rehabilitation and wellness strengthening program.

References

1. Müller J, Weiler M, Schneeweiss A, et al. Preventive effect of sensorimotor exercise and resistance training on chemotherapy-induced peripheral neuropathy: a randomised-controlled trial. Br J Cancer. 2021;125:955–965. doi:10.1038/s41416-021-01471-1
2. Z Wang. Comparison of the effects of 19 exercise interventions on symptoms, pain, balance, and muscular strength in patients with chemotherapy-induced peripheral neuropathy: a systematic review and network meta-analysis. International Journal of Nursing Studies. 2025. PMID: 39946864
3. Natsuki Nakagawa, Sena Yamamoto, Akiko Hanai, Ayano Oiwa, and Harue Arao. Exercise intervention for the management of chemotherapy-induced peripheral neuropathy: a systematic review and network meta-analysis. Front Neurol. 2024;15:1346099.
4. Kneis S, Wehrle A, Müller J, et al. It’s never too late — balance and endurance training improves functional performance, quality of life, and alleviates neuropathic symptoms in cancer survivors suffering from chemotherapy-induced peripheral neuropathy: results of a randomized controlled trial. BMC Cancer. 2019;19:414. doi:10.1186/s12885-019-5645-3
5. Schwenk M, Grewal GS, Holloway D, Muchna A, Garland L, Najafi B. Interactive sensor-based balance training in older cancer patients with chemotherapy-induced peripheral neuropathy: a randomized controlled trial. Gerontology. 2016;62:553–563. doi:10.1159/000442253
6. Streckmann F, Lehmann HC, Balke M, et al. Sensorimotor training and whole-body vibration training have the potential to reduce motor and sensory symptoms of chemotherapy-induced peripheral neuropathy — a randomized controlled pilot trial. Support Care Cancer. 2019;27:2471–2478. doi:10.1007/s00520-018-4531-4
7. Lin WL, Wang RH, Chou FH, Feng IJ, Fang CJ, Wang HH. The effects of exercise on chemotherapy-induced peripheral neuropathy symptoms in cancer patients: a systematic review and meta-analysis. Support Care Cancer. 2021;29:5303–5311. doi:10.1007/s00520-021-06082-3
8. Winters-Stone KM, Horak F, Jacobs PG, et al. Falls, functioning, and disability among women with persistent symptoms of chemotherapy-induced peripheral neuropathy. J Clin Oncol. 2017;35:2604–2612. doi:10.1200/JCO.2016.71.3552